UK stroke services should be urgently reorganised to improve outcomes for patients, argues a senior doctor in this week's British Medical Journal (BMJ).
Studies have found that the UK has the worst outcome in western Europe. In one study, the differences in the proportion of patients dead or dependent between the UK and eight other European countries were between 150 and 300 events per 1,000 patients.
In the BMJ, Professor Hugh Markus at St George's University of London looks at why the outcome is so poor in the UK.
He argues that differences in the process of care are likely to be important. For instance, stroke care is an integral part of neurology in many European countries, but in the UK it has, until recently, been a "Cinderella" subject, often falling between neurology and general and geriatric medicine.
This is not due to underinvestment, however: the cost of care of stroke patients seems to be as high, if not higher, in the UK than in European countries.
Professor Markus suggests several organisational and structural problems, such as poor focus on acute stroke care.
He says a major challenge is to change the perception of stroke among both health professionals and the public, so that stroke is viewed as a condition that requires emergency action.
A 2005 National Audit Office report concluded that, if UK stroke care was better organised, every year £20m could be saved, 550 deaths could be avoided, and 1,700 patients would recover fully who would not otherwise do so.
In response, England's Department of Health National Stroke Strategy is due to publish its recommendations in the autumn.